[Primary amyloidosis. Clinical manifestations]. / Amiloidosis primaria. Manifestaciones clínicas.

Amyloidosis is distinguished by store both localized or systemic, of a substance conformed for 3 fraction: 1) protein (90%), 2) Mucopolysaccharides, 3) fatty and iron, with filament ultrastructure. These filaments are thin and rigid, with beta crystallographic shape. Four pattern of amyloid are distinguished. They are derived of light chains or another immunoglobulins, aminoacids or prealbumin like substance. If all deposits are protein filaments storage, one of their trials would be increased synthesis of them. This is not sufficient and need that these precursor proteins be attrached by macrophages they are subjected to proteolysis and are enclosed extracellularly. We present a female, 55 years old. The hepatic and renal participation permit to suspect an amyloidosis who is confirmed by the presence of monoclonal gammopathy and by biopsy of tissues.

[Primary gastric plasmacytoma. Presentation of a case]. / Plasmocitoma gástrico primario. Presentación de un caso.

A case of primary gastric plasmacytome is presented. The difficulties of the endoscopic diagnosis, including the citology and the biopsy, are emphasised.

[Diarrhea and AIDS: more complex diagnostic techniques; better therapeutic results]. / Diarrea y SIDA: técnicas diagnósticas más complejas; mejores resultados terapéuticos.

During 17 months, 73 HIV-positive patients with diarrhea lasting at least for 14 days, were studied prospectively. The patients had stool specimen examinations negative for enteric pathogens, or positive for one of them, but with no response to specific treatment. All patients were subcomitted to digestive endoscopy and biopsies were taken for microbiological and histological studies. The etiology of the diarrhea could be established in 48 patients (66%). In 45, the cause was an enteric infection. There was association of 2 pathogens in 11 patients, and of 3 in 1 patient. The agents found were: Cryptosporidium (24%), MAI (16%), Giardia lambila (12%), isospora belli (5%), Shigella (5%), Salmonella (5%); Entamoeba histolytica (3%), HSV (3%), tuberculosis (2%), adherent bacteria (2%) and spirochetes (2%). In 3 patients the etiology was not infection, their diagnoses were coeliac disease, lymphoma and idiophatic colonic ulcers, respectively. In 51% of the cases only the examination of endoscopic biopsy specimens could identify the cause of the diarrhea. These results justify the use of these methods to improve diagnosis and therapeutic attempts in these patients.

Electron microscopic appearances of chronic nonspecific duodenitis (bulbitis).

The diagnosis of CND cannot be improved by electron microscopy. The normal duodenal cap and CND have similar ultrastructural appearances on guided endoscopic biopsy.

Biochemical and functional indices of malnutrition in patients with operable, non-microcelullar lung cancer.

INTRODUCTION: The aim of this study was to assess non-microcellular lung cancer patients´ nutritional status impact on psychomotor performance, muscle strength and functional activity. MATERIAL AND METHODS: The study involved 60 consecutive patients admitted to the clinic for surgical treatment due to histologically verified non-microcellular lung cancer. The patients were divided, depending on the stage of weight loss, into two groups: relatively well-nourished--29 patients and those with malnutrition--31 patients. History, physical examination, anthropometric data, biochemical parameters as well as functional tests were carefully noted. RESULTS: Patients qualified for particular groups differed significantly in age, p<0.002. Mean values of albumin, transferrin and total protein for the well nourished patients ranged within proper values. In the malnourished patients they were respectively: 34.05±0.27 g/l, 1.764±0.27 g/l, 68.90±6.39 g/l and the differences were statistically significant. Total loss of urea nitrogen was significantly higher in malnourished patients 13.32±2.92 g/l (p<0.005). The average percentage weight loss in both groups differed significantly 0.111±0.044 vs. 0.031±0.028 at p<0.0005. In the group of malnourished patients the right hand average strength was 26.52±8.06 kg and the left one amounted to 25.35±6.04 kg, The values were significantly lower than the results recorded in well nourished patients: 34.93±11.27 kg, 32,37±11.72 kg, p<0.001. The tapping test average time of the right hand was 19.24±4.04 vs. 16.72±3.06 and of the left one 19.69±3.59 kg vs. 17.48±2.79 kg and were significantly longer in patients suffering from malnutrition (p<0.01). Simple reaction times for dominating hand were longer in the group of patients with malnutrition, for the visual stimulus 0.50±0.08 s vs. 0.45±0.087 s, (p<0.05) and for auditory one 0.43±0.08 vs. 0.39±0.08 s (non significant). CONCLUSIONS: Malnutrition in the course of non-microcellular lung cancer significantly reduces psychomotor function assessed by reaction time to visual and acoustic stimuli as well as efficiency of the functional tests evaluated by tapping test and muscle strength measurement.

Chronic nonspecific duodenitis (bulbitis).

"Bulbitis" was classified by fiberoptic endoscopy in: superficial, erosive and pseudopolypoid. Endoscopic diagnosis of "bulbitis" is reliable, as good agreement was obtained in 100 cases tabulated according to histological grading. Erosive "bulbitis" implies a severe histopathological compromise.

Candidiasis esofágica: análisis clínico y micológico / Oesophageal candidiasis: clinical and mycological analysis

Oesophageal candidiasis is an epithelial infection which requires an immune deficiency. C. albicans is commonly the cause, although other species may also be responsible. Resistance to fluconazole, drug of choice for treatment, is an emerging problem. The objectives of the current paper were: to determine the frequency of oesophageal candidiasis in patients submitted to upper gastrointestinal endoscopy, analyze risk factors, identify Candida species and determine in vitro susceptibility to fluconazole. During 12 months, 34 patients with oesophageal candidiasis were detected. Out of 1.230 HIV negative and 91 HIV positive patients submitted to upper endoscopy, 11 (0.9%) and 23 (25.3%), respectively, had candidiasis. Risk factors for HIV negative patients were systemic antibiotic therapy in 2, deficient dental cleaning in 2 aged patients, use of proton pump inhibitors in 3, inhaled steroids in 2, malignancy in 1 and oral steroids in 1. The histopathologic diagnosis was confirmed in 48.6% of cases. Cultures were positive in 91.2% C. albicans was prevalent (93.5%), and was associated to other species in 5 cases (16.1%), (3 C. glabrata, 1 C. tropicalis and 1 C. parapsilosis). One case cultured only C. glabrata and 1, only C tropicalis. Out of 31 cultures, 25 were susceptible to fluconazole, 4 dose dependent (1 C. albicans, 3 C. glabrata), and 2 resistant (1 C. albicans, 1 C. glabrata). Frequency of oesophageal candidiasis was low, except for HIV positive patients. The most common etiologic agent was C. albicans, though other Candida species were also found. C. albicans and C. glabrata showed dose dependency and resistance to fluconazole.

La candidiasis esofágica es una infección epitelial querequiere un defecto adicional inmunitario. Candida albicans es la especie más frecuente, aunque puedenencontrarse otras. Un problema emergente es la resistenciaal fluconazol, droga de elección para tratarla. Los objetivos fueron: determinar la frecuencia de candidiasisesofágica en pacientes sometidos a endoscopía, analizar los factores predisponentes, identificar las especiescausantes, y estudiar la sensibilidad in vitro al fluconazol. Durante 12 meses se realizaron 1.321 endoscopíasdonde se detectaron 34 pacientes con candidiasis esofágica. Se hicieron 1.230 endoscopías en pacientes HIV negativos y 91 en HIV positivos. Se diagnosticó candidiasis esofágica en 11 (0.9%) y 23(25.3%), respectivamente. En HIV negativos, fueron causas predisponentes: antibioticoterapia prolongada, prótesis dentarias sin higiene, uso prolongado de inhibidoresde la bomba de protones, secreción ácida, corticoides inhalatorios, malignidad y vasculitis bajo corticoterapia. La histopatología fue positiva en 48.6%. El cultivo se desarrolló en el 91.2%. C. albicans fue laespecie más frecuente (93.5%) y en 5 pacientes (16.1%) se la encontró asociada a C. glabrata (3) C. tropicalis (1) y C. parapsilosis (1). En un caso solo se cultivó C. glabrata y en otro C. tropicalis. De las 31 cepas, 25 fueron sensibles al fluconazol, 4 dosis dependientes (1 C. albicans, 3 C. glabrata), y 2 resistentes(1 C. albicans, 1 C. glabrata). En nuestro hospital, la frecuencia de candidiasis esofágica fue baja, excepto enHIV positivos. El principal agente etiológico fue C. alalbicans,aunque también se cultivaron otras especies. C. albicans y C. glabrata mostraron dosis dependencia yresistencia al fluconazol.

Amiloidosis primaria: manifestaciones

La amiloidosis se caracteriza por el depósito tisular, localizado o sistémico, de una sustancia formada por tres fracciones: 1) proteica, 2) mucopolisacáridos, 3) lípidos e hierro, con ultraesctructura fibrilar. Son fibrillas finas, rígidas, con conformación cristalográfica beta, que le da sus propriedades especificas. Se individualizan cuatro tipos de amiloide derivados de la cadenas lovianas y otras inmunoglobulinas, aminoácidos o sustancias similares a la prealbúmina. Si todos los depósitos con acúmulos de fibrilas proteicas, una de sus causas sería la síntesisexcesiva de ellas. Esto no es suficiente y se requiere que estas proteínas precursosras sean captadas por los macrófagos, sometidas a proteolisis y por exocitosis depositadas extracelularmente. Se presenta una paciente de 55 años, en quien la participación hepática y renal hace sospechar uns amiloidosis que se confirma por hallarse una gamapatía monoclonal y por biopsia de tejidos

Amiloidosis primaria. Manifestaciones clínicas / [Primary amyloidosis. Clinical manifestations]

Amyloidosis is distinguished by store both localized or systemic, of a substance conformed for 3 fraction: 1) protein (90

), 2) Mucopolysaccharides, 3) fatty and iron, with filament ultrastructure. These filaments are thin and rigid, with beta crystallographic shape. Four pattern of amyloid are distinguished. They are derived of light chains or another immunoglobulins, aminoacids or prealbumin like substance. If all deposits are protein filaments storage, one of their trials would be increased synthesis of them. This is not sufficient and need that these precursor proteins be attrached by macrophages they are subjected to proteolysis and are enclosed extracellularly. We present a female, 55 years old. The hepatic and renal participation permit to suspect an amyloidosis who is confirmed by the presence of monoclonal gammopathy and by biopsy of tissues.

La gastronómía endoscópica percutánea en pacientes con trastornos deglutorios de origen neurológico. Resultados de un estudio prospectivo multicéntrico internacional / Percutaneous endoscopic gastrostomy in patients with neurological diseases. Results of a prospective multicenter and international study

AIM: To determine prospectively the long-term evolution of patients with neurological diseases after insertion of percutaneous endoscopic gastrostomy (PEG). METHODS: 109 PEG were performed in 99 consecutive patients (49 females, 50 males), mean age 75 years (range: 20-97 years) as an alternative to a nasogastric tube. Patients were enterally fed because of chronic neurological swallowing difficulties: cerebrovascular disease 38, dementia 27, disordered swallowing mechanisms in elderly patients 10, motor neurona disease and multiple sclerosis 10, neuro-surgical disease 6, Parkinson's disease 3, brain tumor 3, neo-natal encephalopathy 1, HIV encephalopathy 1. The procedure took place in a dedicated endoscopy room. In all cases, prophylatic antibiotics were given and the PEG tube was inserted by the "pull" technique. RESULTS: PEG insertion was technically succesful in all cases. After PEG insertion, all patients were subsequently discharged to local nursing home facilities. 85/99 patients were long-term followed-up on an outpatient basis, 25% of them were followed for more than a year. The mean follow-up time was 3 months (range: 1-24 months). The most frequent complication were minor: local wound infection 6, ostomy leakage 8, silicon degradation 16, leading to the removal of the PEG and the placement of a new PEG tubes in 10 cases. Two major complications were observed : one gastric perforation and death 2 months after the PEG placement and one gastrocolic fistula. No aspiration pneumonia was reported. In one patient, PEG was removed after recuperation of a normal swallowing. All patients had a nutritional improvement. A total of 11 deaths occurred during the follow-up, related to the neurological disorder in 10/11 cases. Nursing home team, patient's physicians and patient's families found PEG manipulations easier than naso-gastric tube. CONCLUSION: Our study suggests that PEG is a method of choice for enteral feeding of patients with chronic neurological disorders. PEG is well-tolerated, leading to an improvement in nutritional status and offering good facilities for home nursing.

Duodenitis cronica inespecifica (bulbitis). Estudio endoscopico e histologico. / Chronic nonspecific duodenitis (bulbitis). Endoscopic and histologic study

El presente trabajo compredio el estudio de correlacion endoscopica con la histologica en 27 pacientes con el diagnostico endoscopico de bulbitis cronica inespecifica y 6 pacientes con endoscopia normal. Existe una excelente correlacion histologica-endoscopica en las BCI cuando se estudian muestras multiples de duodeno. Ocasionalmente resulta dificil diferenciar histologicamente entre un bulbo normal y una BCI superficial. El aumento del espacio intercelular determinado por microscopia eletronica, pareceria ser muy frecuente en este ultimo grado de bulbitis. La infiltracion celular de la lamina propia y la reduccion de las celulas caliciformes no son elementos confiables, unicos para el diagnostico. Deben existir alteraciones vellositarias y celulares concomitantes para formular el diagnostico correcto de la BCI por medio de la microscopica de luz

Diarrea y sida: tecnicas diagnosticas mas complejas; mejores resultados terapeuticosx / Diarrhea and aids: diagnosis techniques more completes; best results

Durante 17 meses se esdudiaron prospectivamente 73 pts HIV + con diarrea más de 14 dias de evolución, sin diagnóstico etiológico por el examen de la mf, o bien con coprocultivos positivos, pero sin respuesta al tratamiento específico. A todos se les realizó endoscopía digestiva con tomas de biopsias intestinales para estudio microbiológico (directo y cultivo) e histopatológico. El diagnóstico causal de diarrea pudo realizarse en 48 prs (66 por ciento). En 45, la cuasa fue infecciosa. Hubo asociación de 2 gérmenes en 11 pts y de 3 gérmenes en 1. Los patógenos hallados fueron: Cryptosporidium (24 por ciento), CMV (21 por ciento), MAI (16 por ciento), Giardias (12 por ciento), Isospora belli (5 por ciento), Shigella (5 por ciento), Salmonella (5 por ciento) , Entamoeba histolítica (3 por ciento), HSV (3 por ciento, TBC (2 por ciento), bacteria adherente (2 por ciento) y espiroqueta (2 por ciento). En 3 pts la causa de la diarrea no fue infecciosa, en ellos se diagnosticó respectivamente enfermedad celíaca, linfoma y úlceras inespecíficas de colon. En el 51 por ciento de los casos sólo la endoscopía con biopsia intestinal permitó identificar el agente causal, resultando que justifica el uso de este método como diagnóstico en esta patología.